gas prices and universal health care

[Rich_in_Tampa]

Originally Posted by Grizz

As I've mentioned, gas is just one area where we pay more taxes. Apart from health care funding, our gov't funds and builds things to a similar standard as the U.S. and as such we pay proportionally similar rates for roads, schools etc. I'm not sure why it's that big a leap to think that a big piece of that extra $1.17 per gallon goes toward health.

The leap is from "I thought that this might serve as a good factual example/warning to those in the U.S. who believe that UHC can or will happen without much sacrifice."

What is being leaped over is the fact that health care here already costs about $12,000 per year for a family (variable, to be sure), that another huge chunk of indirect costs are spent from general tax revenues on uncovered care in emergency rooms, that 47K Americans are uninsured, etc. It's not like it will be solely funded with new draconian taxes.

The "sacrifice" referred to is already being paid for, with pathetic results. The direct (tax-supported) costs of a sponsored, fair, and universal system may well be more than offset by savings or better outcomes in other parts of the system. If nothing else, at least everyone would be able to buy insurance, which is currently not the case.

I appreciate your analogy that Canadians pay higher taxes for the most part. But you also get quite a bit in return, at least in the health care area.

[Grizz]

Originally Posted by Calgary_Girl

Just an FYI that I've lived in the States. I can honestly tell you that my husband's net income was the same in the States as it is here in Canada.

So how exactly are we paying higher taxes in Canada again?

Income tax wise we aren't, as long as you are in a lower or middle of the pack tax bracket. Once you start into the $75K + range, things change. Evidenced by the exodus of highly paid health care workers.

[Calgary_Girl]

Originally Posted by Grizz

Income tax wise we aren't, as long as you are in a lower or middle of the pack tax bracket. Once you start into the $75K + range, things change. Evidenced by the exodus of highly paid health care workers.

Sorry, but I still have to disagree. DH is highly compensated (over $140K) and his net income is still the same as it was in the States. The only difference is that they used to nickel and dime us to death in the States for Dr.'s office visits, co-pays, price of prescriptions....

Every time we would visit the Doctor = $15/visit
Prescription co-pays = $15
Cost of prescription (ex. birth control ) = $40 in the States vs. $18 in Canada (3 month supply)

[youbet]

Where's the Zip-Meister? He'll straighten this out!

[Midpack]

Originally Posted by Zathras

It just seems odd that the only thing Canada provides its population differently than the US would be Health care.
I can't say I have anything saying it isn't, I just would like to clarify that.

My understanding they have a pension that sounds considerably more generous (retire earlier, with more money and UHC) than US Soc Security, but I'm sure one of the natives can fill us in, eh?

[kumquat]

Originally Posted by Midpack

My understanding they have a pension that sounds considerably more generous (retire earlier, with more money and UHC) than US Soc Security, but I'm sure one of the natives can fill us in, eh?

For retirees, Canada has:

OAS (Old Age Security) ~6K/year, taxed back if other income is high enough

GIS (Guaranteed Income Supplement) ~7K/year depends on income

CPP/QPP (Canada/Quebec Pension Plan) max ~11K, depends on contributions while working, much like your SS

I have no idea how this compares to the US but am curious

BTW, OAS and GIS at 65. CPP at 60 (benefits drop ~6%/year that you are younger than 65)

Edit to add:
There are tax deferred ways of saving your own money (similar to your 401K?) but it's still your savings.

[Zipper]

I think "Grizz" has had too much Labatt's Blue today!

[Grizz]

What is being leaped over is the fact that health care here already costs about $12,000 per year for a family (

Holy cow, I hate admitting defeat as much as the next guy (maybe more), but I was wrong. I just did some research, and your gov't forks over more per capita already than Canada's for health. Hmmm...so what's with the high gas prices!? Canadian and american health care systems compared - Wikipedia, the free encyclopedia The U.S. system must be badly broken in one or more areas. Sure we have line ups for some things here, and docs leaving for the big money in the U.S., but everyone here gets looked after and nobody goes bankrupt if they break their arm.

Could be a touchy subject here Rich, but according to payscale.com a family physician in the U.S. earns about $30K more per year (about $132K vs $101K) than a Canadian family doc. I'll assume that dropping average doctors wages to Canadian levels to help out in funding universal health care reforms would fly like a cement kite?

Zipper: I'm really interested in this topic and am very willing to learn. If all that you can do is contribute glib comments, why bother.

Calgary Girl..On income taxes, I am usually earning roughly similar dollars as your husband. Right or wrong, this is where I got my info. Brian Dell: North American income tax rates

[Midpack]

Originally Posted by Grizz

I just did some research, and your gov't forks over more per capita already than Canada's for health. Hmmm...so what's with the high gas prices!? The U.S. system must be badly broken in one or more areas.

Not our government, it's mostly private insurance. But our per capita health care costs are among (if not the) highest anywhere. The American system is superior in some respects, but overall it's clearly "broken" IMHO. I'm generally in favor of less government, but our adminstrative costs (at 16-22%) for healthcare are 2, 3 or more times that of most developed nations. Watch this (takes an hour although you could just watch one of five chapters, but it's free and interesting)... FRONTLINE:sick around the world | PBS

[OAG]

I don't know much about the subject as my health care is "free" (I know it isn't really free). But, in the USA we do "give away" a lot of care, but bill for the full amount even tho it is not going to get paid by the recipient. Also a MD may "bill" a $1 (which I assume it the listed cost of the care) but only get reimbursed about $.50, then the Government can claim a 50% "savings". All "smoke and mirrors" and can be argued "any way you want".

[Rich_in_Tampa]

Originally Posted by Grizz

Could be a touchy subject here Rich, but according to payscale.com a family physician in the U.S. earns about $30K more per year (about $132K vs $101K) than a Canadian family doc. I'll assume that dropping average doctors wages to Canadian levels to help out in funding universal health care reforms would fly like a cement kite?

Don't have the data handy, but physician fees account for a very small part of health care costs here -- it's mostly the insurance layer, hospital and longterm care costs, drugs, etc.

As to compensation, the distortions are that an ophthalmologist, radiologist, orthopedist can make half a million or even more. They worked and studied hard for their certifications, but so did the pediatricians, internists and GPs who make in the low or mid-$100ks.

I never really understood why people who do what I do (I'm an academic internist seeing hospitalized cancer patients) is valued at half the worth of an orthopedist, but since I'm doing just fine I don't fret about it.

[Midpack]

I don't see where we are getting better healthcare for this expenditure. We have 47 million (16%) without healthcare, millions who declare bankruptcy for medical reasons - and almost every other country listed provides healthcare for all their citizens and medical bankruptcy is unheard of. I'm a lifelong conservative, but our system is "broken."

Per Capita Health Expenditures by Country, 2007

The sum of public and private expenditure (in purchasing power parity terms in US dollars), divided by the population. Health expenditure includes the provision of health services (preventive and curative), family planning activities, nutrition activities, and emergency aid designated for health, but excludes the provision of water and sanitation.

[kcowan]

I love being retired in Canada. For tax years, 2003-2006, I earned an average income of $55k and paid $2330 in federal and provincial taxes (4.25%).

Of course, sales taxes on purchases would have added 12% (14% in the early years). Through other higher taxes on liquor and gasoline, I estimate that we paid another $10k/year when compared to San Diego (where we spent every May), so the apples to apples comparison is 22.5%/year in taxes.

Of course, when we spend time in San Diego and Mexico, we avoid all those extra sales taxes. (posted from PV)

In 2007, we filed jointly and only on Wednesday, so the results are not final yet. Joint filing alllows me to split my pension income and she gets extra pension deductions. This is a new provision.

[Calgary_Girl]

Originally Posted by Grizz

Hmmm...so what's with the high gas prices!? The U.S. system must be badly broken in one or more areas. Sure we have line ups for some things here, and docs leaving for the big money in the U.S., but everyone here gets looked after and nobody goes bankrupt if they break their arm.

Taxes, taxes, taxes. You probably already know this, but here's how the cost of gas in Canada is broken down:

Retail Price of Regular Gasoline in Canada - January 2008
(CAN cents/litre)

As for people going bankrupt in the U.S. due to medical bills, I remember hearing that the majority of bankruptcies are due to this reason, and those individuals had insurance! Medical bills trigger half of all bankruptcies - Money - MSNBC.com

"Most of those seeking court protection from creditors had health insurance, with more than three-quarters reporting they had coverage at the start of the illness that triggered bankruptcy. The study said 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy, with illness frequently leading to the loss of both a job and insurance.
Out-of-pocket medical expenses covering co-payments, deductibles and uncovered health services averaged $13,460 for bankruptcy filers who had private insurance at the onset of illness, compared with $10,893 for those without coverage. Those who initially had private coverage but lost it during their illness faced the highest cost, an average of $18,005."

[youbet]

Originally Posted by Rich_in_Tampa

I never really understood why people who do what I do (I'm an academic internist seeing hospitalized cancer patients) is valued at half the worth of an orthopedist, but since I'm doing just fine I don't fret about it.

And that's not just in the medical profession Rich.......

Unless there is some interference to the open market system such as govt regs, unions, business monopoly or oligopoly, etc., wages are ultimately determined in the open market. The results can defy one's common sense. But in the end, it's a much better system than having a govt committee try to "value" jobs by some criteria such as training required, etc.

[Meadbh]

Originally Posted by BoutDone

How many of us ERs would there be on this board if 46% of our income went to taxes?

Let's put this in perspective. 46% would be the marginal tax rate for high income earners, of which I presume Grizz is one.

My corporation and I earned over $250K in 2007, including the proceeds of investments. My effective total income tax rate was 20.9% and it would have been lower if I hadn't done some asset reallocation that triggered significant capital gains. It's all in how you structure income and for me, incorporation is the key to tax efficient saving for ER. That said, unfortunately incorporation is not an option for many people.

[Meadbh]

Originally Posted by Grizz

Income tax wise we aren't, as long as you are in a lower or middle of the pack tax bracket. Once you start into the $75K + range, things change. Evidenced by the exodus of highly paid health care workers.

The last sentence is supported by the facts...

"In 2006, there were 32 241 family physicians and general practice physicians and 30 656 medical and surgical specialists in Canada.19 On average each year since 1996, 1642 physicians have graduated from medical school and 1683 physicians have graduated from residency training programs in Canada.11,12 Each year from 1995 to 2004, an average of 517 physicians who completed residency training in Canada left the country and 273 returned from abroad (Fig. 1). For the first time in 2004, the number of physicians who returned from abroad was higher than the number that left the country:1 262 physicians who completed their residency training in Canada left the country and 317 returned. We found that Canada contributed about 186 active, direct-patient care physicians to the US health care system annually (range 37–26"

The Canadian contribution to the US physician workforce -- Phillips et al. 176 (: 1083 -- Canadian Medical Association Journal

[Meadbh]

Originally Posted by Grizz

Could be a touchy subject here Rich, but according to payscale.com a family physician in the U.S. earns about $30K more per year (about $132K vs $101K) than a Canadian family doc. I'll assume that dropping average doctors wages to Canadian levels to help out in funding universal health care reforms would fly like a cement kite?

Considering that many MDs get out of school with over $100K in debt, cement kites and lead balloons should not surprise anyone!

[Meadbh]

Originally Posted by Rich_in_Tampa

Don't have the data handy, but physician fees account for a very small part of health care costs here -- it's mostly the insurance layer, hospital and longterm care costs, drugs, etc.

As to compensation, the distortions are that an ophthalmologist, radiologist, orthopedist can make half a million or even more. They worked and studied hard for their certifications, but so did the pediatricians, internists and GPs who make in the low or mid-$100ks.

I never really understood why people who do what I do (I'm an academic internist seeing hospitalized cancer patients) is valued at half the worth of an orthopedist, but since I'm doing just fine I don't fret about it.

Physician fees accounted for 13% of healthcare costs in Canada in 2006 and that percentage is not rising. http://secure.cihi.ca/cihiweb/produc...06_chap1_e.pdf

Here are a bunch of financial trend data.....
http://secure.cihi.ca/cihiweb/produc...975_2007_e.pdf
To understand why US residents are paying so much for private health insurance in ER, take a look at Figure 34, Private Sector Health Expenditure as a Percent of GDP, Twenty-Three Selected Countries, 2005. One of the principal reasons healthcare costs so much in the US is high administration costs.

Rich, I'm with you on the financial inequities between medical specialties. It seems that procedures and technical wizardry are always allocated more monetary "value" than intellectual input and support.

[Zipper]

Originally Posted by Grizz

Holy cow, I hate admitting defeat as much as the next guy (maybe more), but I was wrong. I just did some research, and your gov't forks over more per capita already than Canada's for health. Hmmm...so what's with the high gas prices!? Canadian and american health care systems compared - Wikipedia, the free encyclopedia The U.S. system must be badly broken in one or more areas. Sure we have line ups for some things here, and docs leaving for the big money in the U.S., but everyone here gets looked after and nobody goes bankrupt if they break their arm.

Could be a touchy subject here Rich, but according to payscale.com a family physician in the U.S. earns about $30K more per year (about $132K vs $101K) than a Canadian family doc. I'll assume that dropping average doctors wages to Canadian levels to help out in funding universal health care reforms would fly like a cement kite?

Zipper: I'm really interested in this topic and am very willing to learn. If all that you can do is contribute glib comments, why bother.

Calgary Girl..On income taxes, I am usually earning roughly similar dollars as your husband. Right or wrong, this is where I got my info. Brian Dell: North American income tax rates

Nice to see you woke up out of your stupor Grizz.

And you wonder why I thought you had downed a case of Blue?